Longitudinal goal attainment with integrated upper limb spasticity management including repeat injections of botulinum toxin a: Findings from the prospective, observational upper limb international spasticity (ulis-iii) cohort study

Objective: To assess the longitudinal effects of integrated spasticity management incorporating repeated cycles of botulinum toxin A type A (BoNT-A) over 2 years. Methods: The Upper Limb International Spasticity study was a prospective, observational, cohort study following adult patients over 2 years of integrated upper-limb spasticity management including repeat botulinum toxin (BoNT-A) treatment (any commercially-available product). Results: A total of 1,004 participants from 14 countries were enrolled, of which 953 underwent 1 BoNT-A injection cycle (median 4 cycles) and had 1 goal attainment scaling assessment. Most participants (55.9 64.6% across cycles 1 6) saw a therapist after BoNT-A treatment; the most frequent therapy intervention was passive stretch (70.1 79.8% across cycles 1 6). Patients achieved their goals as expected over repeated cycles; mean cumulated goal attainment scaling T-score at 2 years was 49.5 (49.1, 49.9). Mean goal attainment scaling change scores of 10 were maintained across up to 7 cycles. Higher rates of goal achievement were seen for primary goals related to passive vs active function (86.6% vs 71.4% achievement). Standardized measures of spasticity, pain, involuntary movements, active and passive function improved significantly over the study. Conclusion: This large, international study provides evidence for benefit of repeated cycles of BoNT-A, over 2 years captured through person-centred goal attainment and standardized measures.